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repro Flashcards

1
Q

what is the folic acid dose for a healthy mother?

A

400 micrograms per day

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2
Q

what is the folic acid dose for women w/ underlying health conditions?

A

5mg per day

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3
Q

what is chorioamnionitis?

A

infections of the membranes in the uterus

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4
Q

what is the recommended first line pain killer in pregnancy?

A

paracetamol - crosses the placental membrane but is not teratogenic

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5
Q

can codeine phosphate be taken in pregnancy?

A

yes at low doses if it is needed

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6
Q

how does vasa praevia present?

A

rupture of membranes followed immediately by vaginal bleeding

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7
Q

what is dysfunctional uterine bleeding?

A

menorrhagia w/ no underling pathology

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8
Q

what is the most common cause of bleeding in post menopausal women?

A

atrophic vaginitis

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9
Q

what is the first line for dysfunctional uterine bleeding?

A

merina coil

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10
Q

does hyper or hypothyroidism cause menorrhagia?

A

hypothyroidism

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11
Q

what is the advantage of skin patch HRT compared to oral tablet HRT?

A

reduced VTE risk

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12
Q

what is premature ovarian failure?

A

menopause before 40

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13
Q

what are the blood results in premature ovarian failure?

A

low / no oestrogen

high FSH and LH (due to no -ve feedback to the pituitary)

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14
Q

what is the treatment for CIN || and ||| and why?

A

large loop excision of the transformation zone (LLETZ) because they often progress to invasive cancer (unlike CIN | which often regresses)

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15
Q

what is the whirlpool sign indicative of?

A

ovarian torsion

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16
Q

what is a cystocele?

A

herniation of the bladder into the vagina

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17
Q

what is the first line imaging modality to investigate ovarian pathology?

A

USS

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18
Q

what condition causes difficulty palpating the foetal parts?

A

polyhydramnios

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19
Q

what is a potential complication of polyhydramnios and why?

A

umbilical cord prolapse because the excess amniotic fluid can prevent engagement of the presenting part and leave room for the cord to get past (prolapsing)

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20
Q

what is the time frame for the anomaly scan?

A

18-20+6 wks

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21
Q

what is the management for a pregnant pt. w/ hyperemesis gravidarum and why?

A

thiamine supplements

because intractable vomiting can result in thiamine deficiency which can cause wernickies encephalopathy and result in foetal death

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22
Q

what is the test used to investigate downs at 15 wks?

A

the quadruple test (used after 13 wks gestation)

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23
Q

what is the test used to investigate downs at 12 wks?

A

the combined test (first test used and can be used between 11-13+6 wks)

combined test = nuchal translucency + hormone levels in the blood

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24
Q

what is naegles rule used to calculate?

A

estimated date of delivery based on the date of the last menstrual period

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25
Q

how do you calculate the EDD using naegles rule?

A

add one year and 7 days to the last menstrual period and subtract 3 months

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26
Q

what is a membrane sweep and when is it offered?

A

a finger is inserted into the cervical opening and a sweeping movement is done to separate amniotic membranes from the cervix

done in post term pregnancy

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27
Q

what is the kleihauer test done for?

A

to quantify the dose of Rh D antigen in the maternal circulation

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28
Q

how does congenital toxoplasmosis present?

A

CNS problems
visual impairment
hearing loss

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29
Q

how is toxoplasmosis acquired?

A

exposure to cat faeces

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30
Q

what is the management of a pregnant pt who has hypothyroidism but is euthryoid on her current levothryoxine dose?

A

increase the levothyroxine dose by 25mcg and repeat thyroid function tests in 4 wks

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31
Q

what is frank breech?

A

legs are fully extended up to the shoulders and the presenting part is at the pelvic inlet

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32
Q

what kind of HRT is given to menopausal women w/ symptoms who still have regular periods?

A

monthly, cyclical HRT

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33
Q

what kind of HRT is given to postmenopausal women?

A

continuous combined HRT

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34
Q

what is the contraceptive used in a pt who is 3wks post partum and is breast feeding?

A

progesterone only pill

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35
Q

when can the IUD be fitted after delivery?

A

up to 48 hrs after or 4 wks post partum

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36
Q

what is the most common ovarian cancer?

A

epithelial ovarian cancer

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37
Q

what is the most likely ovarian cancer in pre menopausal women?

A

germ cell ovarian cancer

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38
Q

what is the treatment option for a woman w/ cervical cancer who wants to remain fertile?

A

radical trachelectomy (removal of the cervix, upper vagina and pelvic lymph nodes)

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39
Q

what is a choriocarcinoma?

A

a tumour that arises when the fertilised ovum forms abnormal trophoblastic tissue instead of a foetus

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40
Q

when should a choriocarcinoma be suspected?

A

after the evacuation of a hydatidiform mole if bHCG levels do not fall

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41
Q

at what bishops score should induction of labour be carried out?

A

8 or more

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42
Q

what does a tender woody uterus indicate?

A

placental abruption

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43
Q

what is a planned external cephalic version?

A

proceedure that aims to manually turn the baby

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44
Q

when is planned external cephalic version done?

A

if the baby is still breech at 36 wks

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45
Q

why is methotrexate contraindicated in pregnancy?

A

because it is a folic acid antagonist

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46
Q

what are the foetal defects seen in methotrexate use during pregnancy?

A

anencephaly

hydrocephalus

cleft lip / palate

skull defects

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47
Q

what type of previous C section is an absolute contraindication for a vaginal delivery

A

classic C section (vertical)

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48
Q

what is the first line treatment for hyperemesis gravidarum?

A

promethazine

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49
Q

what is primary amenorrhoea defined as?

A

failure to establish mensuration by 15 in girls w/ normal secondary sex characterisitics (e.g. breast bud development)

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50
Q

what is the most common type of ovarian cancer?

A

epithelial ovarian cancer

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51
Q

what is the most common subtype of epithelial ovarian cancer?

A

serous

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52
Q

what is the most common class of ovulation disorder?

A

normogonadotrophic normoestrogenic anovulaion

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53
Q

what is the reason for anovulatiton in PCOS?

A

there is normal gonadotrophin levels and normal oestrogen levels however in the follicular phase FSH can be low causing anovulation

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54
Q

division between day 4-8 after fertilisation results in what type of twins?

A

monozygotic twins w/ diamniotic and dichorionic placentation

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55
Q

division between day 8-12 after fertilisation results in what type of twins?

A

monozygotic twins w/ monoamniotic and monochorionic placentation

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56
Q

what is the typical finding on ABG in hyeremesis gravidarum?

A

metabolic alkalosis

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57
Q

fibroids causing difficulty conceiving are likely to be located where and why?

A

submucosal because here they lie in the uterine cavity and disrupt the process of embryo implantation

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58
Q

which feature is not assoc w/ hyperemesis gravidarum and may point to another pathology?

A

abdo pain

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59
Q

psammoma bodies are seen in which ovarian cancer?

A

serous cystadenocarcinoma

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60
Q

what are the 3 types of benign surface derived ovarian tumour?

A

serous cystadenoma
mucinous cystadenoma
brenner tumour

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61
Q

what are the 2 types of malignant surface derived ovarian tumour?

A

serous cystadenocarcinoma

mucinous cystadenocarcinoma

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62
Q

germ cell ovarian tumours are more common in what age group?

A

adolescent girls

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63
Q

what is the most common germ cell ovarian tumour?

A

teratoma (90%)

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64
Q

what are the 2 types of teratoma?

A

mature teratoma aka dermoid cyst- benign

immature teratoma - malignant

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65
Q

what are the 4 types of germ cell ovarian tumours?

A

teratoma
dysgerminoma
yolk sac tumour
choriocarcinoma

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66
Q

what kind of ovarian cancer is a granulosa cell tumour?

A

a malignant sex cord stromal tumour

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67
Q

what kind of ovarian tumour is a sertoli leydig cell tumour?

A

a benign sex cord stromal tumour

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68
Q

what kind of ovarian tumour is a fibroma?

A

a benign sex cord stromal tumour

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69
Q

smoking is a protective factor against which cancer?

A

endometrial

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70
Q

how does ellaone (ullipristal) work as emergency contraception?

A

selective progesterone receptor modulator and primary mechanism of action is inhibition of ovulation

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71
Q

what kind of epithelium lines the ectocervix?

A

stratified squamous non keratinised

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72
Q

what kind of epithelium lines the endocervix?

A

mucous secreting simple columnar epithelium

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73
Q

how does the cervical screening programme work?

A

all women are initially screening for high risk HPV between the ages of 25-64 and then if that is +ve the same sample is analysed for abnormal cytology

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74
Q

which vessel supplies the greatest contribution to the arterial supply of the breast?

A

the internal mammary artery

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75
Q

how should a pregnant woman w/ 3 risk factors for thromboprohylaxis be treated?

A

started on low molecular weight heparin from 28 wks until 6wks post natal

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76
Q

how should a pregnant woman w/ >3 risk factors for thromboprophylasix be treated?

A

started on low molecular weight heparin immediately until 6 wks post natal

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77
Q

what is adenomyosis?

A

the presence of endometrium in the myometrium

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78
Q

diabetes in pregnancy causes a risk of what 6 things?

A 
macrosomia 
polyhydramnios 
shoulder dystocia 
neonatal hypoglycaemia
congenital heart abnormalities 
neural tube defects
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79
Q

what is the most common cause of pelvic inflammatory disease?

A

chlamydia

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80
Q

what findings on combined test screening are indicative of downs?

A

increased nuchal translucency on USS
increased HCG
decreased

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81
Q

how do sperm prevent polyspermy?

A

through the release of Ca ions

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82
Q

schiller duval bodies are pathognomonic of what ovarian tumour?

A

yolk sac tumour

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83
Q

what is the most common breast cancer?

A

invasive ductal carcinoma

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84
Q

what is the mechanism of action of tamoxifen?

A

selective oestrogen receptor modulator

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85
Q

which lymph nodes drain the medial part of the breast?

A

internal thoracic

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86
Q

which lymph nodes drain the lateral part of the breast?

A

axillary

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87
Q

what is the first line for the medical management for a miscarriage w/ retained products of conception?

A

vaginal misoprostol

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88
Q

what is the most common C section incision?

A

suprapubic incision

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89
Q

what volume of amniotic fluid is considered polyhydramnios?

A

2-3l

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90
Q

what is the first line antibiotic for a UTI in pregnancy?

A

nitrofurantoin

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91
Q

what are variable decelerations usually due to?

A

cord compression

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92
Q

which condition is gestational trophoblastic disease strongly assoc w/?

A

thyroid dysfunction

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93
Q

what is the advice regarding breast feeding in a mother who has HIV?

A

breast feeding should be avoided and the baby should have antiretroviral therapy for 4-6wks

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94
Q

what is the follow up for a woman who had gestational diabetes?

A

fasting plasma glucose test done at 6-13 wks post partum

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95
Q

what is the management of a woman w/ gestational diabetes and a fasting plasma glucose of >7mmol/l?

A

immediately start on insulin

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96
Q

what is the management of a woman w/ gestational diabetes and a fasting plasma glucose of <7mmol/l?

A

lifestyle advice and if this doesnt work then insulin

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97
Q

what is the first line treatment for menorrhagia?

A

the merina coil (aka levonorgesterel IUS)

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98
Q

what is primary dysmenorrhoea?

A

crampy lower abdo pain at the time of mesntruation

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99
Q

what is the most common type of incontience in women?

A

stress incontinence

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100
Q

what is the first line for the treatment of severe PMS?

A

fluoxetine (SSRI)

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101
Q

what is the first line in the treatment of moderate PMS?

A

COCP

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102
Q

how is trichomonas vaginalis diagnosed?

A

direct visualization, wet mount microscopy and high vaginal swab

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103
Q

what is the most common type of vulval cancer?

A

squamous cell carcinoma

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104
Q

where in relation to the uterine artery do the ureters run?

A

ureters run inferior to the uterine artery (water under the bridge)

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105
Q

what are the cortisol and aldosterone levels in sheehan syndrome?

A

cortisol low

aldosterone normal

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106
Q

which phase of the menstrual cycle is variable?

A

the follicular phase

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107
Q

what is the main function of LH?

A

cause ovulation

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108
Q

what is the effect of rising oestrogen levels on FSH and LH?

A

rising oestrogen levels cause a -ve feedback and stop the release of FHS and LH from the anterior pituitary and stop the release of GnRH from the hypothalamus which further decreases FSH and LH levels

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109
Q

how does the LH surge before ovulation occur?

A

there is a drop in oestrogen levels and so the -ve feedback is turned off, increasing LH levels

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110
Q

which hormone is released by the corpus luteum?

A

progesteroen

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111
Q

if fertilisation occurs what keeps the corpus luteum alive?

A

hCG

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112
Q

if fertilisation does not occur how does the cycle restart?

A

the corpus luteum degenerates and so progesterone and oestrogen levels fall and this turns off the -ve feedback to the hypothalamus and anterior pituitary and so levels of FSH and LH start to rise again

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113
Q

how does menstruation occur?

A

the corpus luteum degenerates and so progesterone and oestrogen levels fall and this causes the endometrium to break down, allowing menstruation to occur

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114
Q

explain the management of stress incontinence

A

first line - life style modification (weight loss) and pelvic floor exercises

second line - surgery

third line - duloxetine (only if not suitable for / doesnt want surgery)

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115
Q

explain the management of urge incontinence

A

first line - conservative (weight loss, reduce caffeine and bladder training)

second line - medical management w/ anti muscarininc

third line - surgical botox

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116
Q

what is pelvic inflammatory disease?

A

chronic inflammation of the pelvis as a consequence of infection (usually chlamydia)

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117
Q

what is the main risk factor for endometrial cancer?

A

oestrogen exposure (early menarche, late menopause, nulliparity, unopposed oestrogen)

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118
Q

what is the most common type of endometrial cancer?

A

adenocarcinoma

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119
Q

how do most endometrial adenocarcinomas arise?

A

from endometrial hyperplasia

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120
Q

what is the diagnosis of a woman w/ post menopausal bleeding until proven otherwise?

A

endometrial cancer

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121
Q

COCP is protective for which 2 cancers?

A

endometrial

ovarian

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122
Q

what is the most common cervical cancer and what is it caused by?

A

squamous cell carcinoma caused by HPV

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123
Q

which cancer is smoking protective for?

A

endometrial

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124
Q

which 2 cancers are smoking a risk factor for?

A

ovarian and cervical

125
Q

what is cervical intraepithelial neoplasia (CIN)?

A

a precursor lesion of invasive cervical carcinoma

126
Q

what is the age group for cervical cancer?

A

25-44

127
Q

what medication can be used pre surgery to reduce the size of fibroids?

A

GnRH agonists

128
Q

what is red degeneration?

A

a pregnancy related complication of fibroids where they rapidly enlarge and outgrow their blood supply

129
Q

what is the likely diagnosis of a pregnant woman w/ a history of fibroids who presents w/ severe abdo pain and low grade fever?

A

red degeneration

130
Q

what is the gold standard investigation for a diagnosis of endometriosis?

A

explorative laparotomy

131
Q

what is a contraindication for the COCP?

A

migraine w/ aura

132
Q

where do ectopic pregnancies usually occur?

A

in the ampulla

133
Q

an ectopic pregnancy in which site is most likely to rupture?

A

the isthmus (narrower)

134
Q

what is the best way to check a females ovulatory status?

A

day 21 progesterone level

135
Q

where is the most common site for referred pain from the ovaries and why?

A

the periumbilical region because the sympathetic nerve supply to the ovary originates at T10 (which is the level of the umbilicus)

136
Q

what is the treatment for bacterial vaginosis?

A

metronidiazole 400mg twice a day for a week

137
Q

how does BV present?

A

painless thin grey ish watery discharge w/ a fishy odour

138
Q

when does PMS occur?

A

in the late luteal phase

139
Q

what is complete androgen insensitivity syndrome (AIS)?

A

where the cells cannot respond to androgens at all

140
Q

how does complete androgen insensitivity syndrome present?

A

secondary sex characteristics and external genitalia of a woman but do not have a uterus and have undescended testes in the abdo

141
Q

what is partial androgen insensitivity syndrome (AIS)?

A

where the cells can partially respond to androgens

142
Q

how does partial androgen insensitivity syndrome present?

A

phenotype can vary (due to partial response to androgens)

can present w/ normal female / male sex characteristics or the presence of both

143
Q

what is mild androgen insensitivity syndrome (AIS)?

A

where the cells respond to androgens to some extent

144
Q

how does mild androgen insensitivity syndrome present?

A

born w/ male sex characteristics but are infertile

145
Q

what is the karyotype in androgen insensitivity syndrome?

A

46 XY

146
Q

what is the most common cause of a clear, non itchy vaginal discharge?

A

ectropion

147
Q

HRT increases the risk of which cancer?

A

breast

148
Q

what are the classic features of turners syndrome?

A

short stature webbed neck

149
Q

what is the karyotype for turners syndrome?

A

45 XO

150
Q

what is the hormonal profile in turners syndrome?

A

hypergonadotrophic hypogonadism

low oestradiol despite high FSH and LH

151
Q

what is syphilis caused by?

A

treponema pallidum

152
Q

how does primary syphilis present?

A

as a painless genital ulcer known as a chancre

153
Q

when do symptoms of secondary syphilis present?

A

2-8wks after the primary chancre

154
Q

what are the symptoms of secondary syphilis?

A

maculopaupular rash on the hands and soles, generalised lymphadenopathy, flu like symptoms and condylomata (white infectious wart like thing)

155
Q

slit like appearance of the nipple indicates what?

A

duct ectasia

156
Q

what is the nipple discharge seen in duct ectasaia?

A

green brown discharge

157
Q

what is the appropriate management of a symptomatic woman who had a failed medical management of miscarriage?

A

surgical evacuation of products of conception

158
Q

what is the first line treatment for infertility in women w/ PCOS who wish to conceive?

A

clomifene citrate

159
Q

how does clomifene citrate improve fertility in women w/ PCOS?

A

it binds to oestrogen receptors, preventing oestrogen from binding and so the -ve feedback of oestrogen on FSH and LH is lifted, allowing the conc of FSH and LH to increase and hence ovulation is triggered

160
Q

what is the second line treatment for infertility in women w/ PCOS who wish to conceive and clomifene citrate didnt work?

A

clomifene citrate and metformin

161
Q

ovid mobile parasites on wet saline mount indicates what?

A

trichomoniasis

162
Q

clue cells on wet saline mount indicates what?

A

BV

163
Q

what is a mammary duct fistula?

A

an epithelial lined connection between the periareolar skin and the underlying duct

164
Q

how can you differentiate pagets from eczema?

A

pagets affects the nipple first rather than the areola and pagets is unilateral

165
Q

what is aortocaval compression?

A

supine hypotensive syndrome

hypotension in the supine position (lying down) that occurs in pregnant women >20 wks gestation

166
Q

when does amniotic fluid embolism occur?

A

during labour and / or up to 48 hrs after

167
Q

what is an amniotic fluid embolism?

A

when amniotic fluid and / or foetal cells enter the maternal circulation and cause cardiopulmonary arrest

168
Q

why does oesophageal atresia cause polyhydramnios?

A

because oesophageal atresia is a swallowing abnormality in the foetus and this impairs the circulation of the amniotic fluid causing polyhydramnios

169
Q

why is menopause assoc w/ an increase in FSH?

A

because in menopause there is a decrease in oestrogen and so this switches off the -ve feedback loop on FSH and so there is an increase in FSH

170
Q

what is the most accurate blood test to confirm menopause?

A

FSH (increased)

171
Q

women w/ gestational diabetes should give birth no later than when?

A

40 + 6 wks

172
Q

what is the ultrasonographic criteria for PCOS?

A

ovarian vol > 10ml

OR

at least 12 follicles in one ovary measuring 2-9mm in diameter

173
Q

what are the recommendations regarding breast feeding?

A

exclusive breast feeding for 6 months then a combo of foods and breast feeding until 2 years or beyond

174
Q

what is the only clinical diagnostic feature of adenomyosis?

A

enlarged uterus

175
Q

what is adenomyosis?

A

endometriosis of the musculature

176
Q

how is adenomyosis diagnosed?

A

based on cyclical pain w/ menses and enlarged uterus

177
Q

what is the anticholinergic used in the management of urge incontinence?

A

oxybutinin

178
Q

what is turtling of the babys head a sign of?

A

shoulder dystocia

179
Q

what is the likely diagnosis of a woman who collapsed suddenly after the delivery of the placenta and the outline of the uterine fundus cannot be palpated?

A

uterine inversion

180
Q

list 4 high risk factors for developing pre eclampsia?

A

previous pre eclampsia
type 1 or 2 diabetes
essential hypertension
CKD

181
Q

list 5 moderate risk factors for developing pre eclampsia?

A 
BMI > 35 at booking 
FHx of pre eclampsia 
maternal age > 40 
first pregnancy 
multiple pregnancy
182
Q

what is the most common cause of DIC in pregnancy?

A

placental abruption

183
Q

where is the main lymphatic drainage of the ovary?

A

para aortic lymph nodes

184
Q

what is the AB used in asymptomatic bacterurima in the first and second trimesters of pregnancy?

A

nitrofurantoin

185
Q

what is the AB used in asymptomatic bacterumia in the third trimester of pregnancy?

A

trimethoprim

186
Q

what is the first line treatment in pts w/ menorrhagia and dysmenorrhoea who do not want the mirena coil?

A

mefenamic acid (NSAID)

187
Q

what is a contraindication for the use of mefenamic acid in the management of menorrhagia and why?

A

IDB because NSAIDs increase GI bleeding

188
Q

what is used in the treatment of pts w/ menorrhagia and dysmenorrhoea who do not want the mirena coil and who have IBD?

A

tranexamic acid (antifibrinolytic)

189
Q

what is sheehans syndrome?

A

hypopituitarism secondary to pituitary infarction due to haemorrhagic shock in labour and post partum

190
Q

explain the sites of blood formation in the developing foetus

A

blood products are first produced by the yolk sac

by 8 wks the yolk sac is replaced by the liver as the main site

by 20 wks (4 months) the bone marrow is the main site

191
Q

what is the physiological explanation for dyspnoea in pregnancy?

A

there is an increased tidal vol resulting in increased minute ventilation and the increased resp workload results in the feeling of breathlessness

192
Q

what is laparoscopy and dye and when is it done?

A

method if investigating tubal patency in women w/ known co morbidities such as endometriosis w/ normal blood tests etc

193
Q

what is the first line and most effective management of women struggling to breast feed?

A

organising a one to one visit from the health visitor

194
Q

what is the first line treatment for chlamydia?

A

doxycycline 100mg twice daily for 7 days

195
Q

what is the treatment for chlamydia if doxycycline is contraindicated or not tolerated?

A

azithromycin 1g orally as a single dose and then 500mg orally for 2 days

196
Q

what is the first line management of gonorrhoea?

A

ceftriaxone 1g IM

197
Q

how is chalmydia diagnosed?

A

NAAT test

198
Q

what is the treatment for BV?

A

oral metronidazole 400mg twice a day for 5 to 7 days

199
Q

what is the treatment for BV in a woman who wont comply to treatment for a wk?

A

a single dose of metronidazole 2g

200
Q

what is the treatment for trichomoniasis?

A

oral metronidazole 400mg twice a day for 5 to 7 days

201
Q

what is the treatment for pelvic inflammatory disease?

A

ceftriaxone 1g as a single IM dose followed by oral doxycycline 100mg twice daily and oral metronidazole 400mg twice daily for 14 days

202
Q

how is the diagnosis of HIV confirmed?

A

HIV PCR and p24 antigen tests

203
Q

how is HIV managed?

A

start highly active anti retroviral therapy (HAART) as soon as diagnosis is made regardless of CD4 count

204
Q

what are the rules regarding HIV and pregnancy delivery?

A

vaginal delivery possible if viral load undetectable at 36wks

C section necessary if viral load detectable

205
Q

what is the PEP given to neonates whos mother has HIV?

A

if viral load is detectable - triple therapy

if viral load is undetectable - mono-therapy

206
Q

what is the broad ligament?

A

a double layer of peritoneum

207
Q

what is the function of the broad ligament?

A

to help keep the uterus in its correct midline position

208
Q

what is the round ligament?

A

an embryological remnant

209
Q

what is the most common position of the uterus?

A

anteverted and anteflexed

210
Q

how can the position of the uterus be determined?

A

by palpation on bimanual examination

211
Q

what is the perineal body and why is it important?

A

bundle of collagen and elastic tissue into which the perineal muscles attach

important for pelvic floor strength

212
Q

what is the function of bartholins glands?

A

secrete lubricating fluid

213
Q

the internal mammary artery (main blood supply to breast) is a branch of which artery?

A

subclavian

214
Q

what is a common position of the uterus (not anteverted anteflexed)?

A

retroverted retroflexed

215
Q

which blood results are caused by teratomas?

A

raised hCG and aFP

216
Q

what are the protective factors for ovarian cancer?

A

factors that stop ovulation or reduce the number of lifetime ovulations

pregnancy
COCP
breast feeding

217
Q

women under 40 who are suspected to have ovarian cancer are likely to have what type of ovarian cancer?

A

germ cell tumours (teratoma)

218
Q

why does tamoxifen increase the risk of breast cancer?

A

because even though it has an anti oestrogenic effect on breast tissue it has an oestrogenic effect on endometrial tissue and therefore increases the risk of endometrial cancer

219
Q

what are the 2 most common cervical cancers?

A
  1. squamous cell carcinoma

2. adenocarcinoma

220
Q

what is the age bracket for cervical screening every 3 years?

A

25-49

221
Q

what is the age bracket for cervical screening every 5 years?

A

50-64

222
Q

what are the types of breech presentation?

A

complete breech
incomplete breech
frank breech aka extended breech
footling breech

223
Q

how does complete breech present?

A

sitting cross legged

224
Q

how does incomplete breech present?

A

sitting w/ one leg crossed and one leg up

225
Q

how does frank breech present?

A

both legs up

226
Q

how does footling breech present?

A

w/ one foot presenting though the cervix w/ foot extended

227
Q

which structures on the foetal skull outline the vertex?

A

anterior and posterior fontanelles and the parietal eminences

228
Q

what is the legal limit for a social termination of pregnancy?

A

23 wks + 6 days

229
Q

what is the first line investigation for chlamydia in an asymptomatic female?

A

first void NAAT

230
Q

COCP is protective against which cancer?

A

ovarian and endometrial

231
Q

lymph from the gonads drain to which group of lymph nodes?

A

lumbar

232
Q

when starting the progesterone only pill how many days of additional protection are needed?

A

if commended up to and including day 5 of the cycle it will provide immediate protection

if commenced after day 5 of the cycle additional methods of contraception should be used for 2 days

233
Q

what is the management of placental abruption when the foetus us alive, <36 weeks old and not showing any signs of foetal distress?

A

admit and administer steroids

234
Q

after using levonelle for emergency contraception when can hormonal contraception be started?

A

immediately

235
Q

what is the safest form of contraception in personal / family history of breast cancer or confirmed BRAC1?

A

copper coil

236
Q

what is the most appropriate management of a pt presenting with symptoms highly suggestive of thrush (white lumpy discharge with no smell and no other symptoms)?

A

first line treatment fluconazole 150mg oral capsule as a single dose

high vaginal swab not needed for diagnosis

237
Q

what is the risk of using SSRIs during pregnancy?

A

there is a small risk of congenital heart defects

238
Q

what is the bacterium that causes group B streptococcus disease?

A

streptococcus galacticae

239
Q

what happens to blood pressure during pregnancy?

A

falls in the first half of pregnancy

240
Q

what is the primary mode of action of the copper coil?

A

decreases sperm motility and survival

241
Q

what is the primary mode of action of the combined pill?

A

inhibits ovulation

242
Q

what is the primary mode of action of the progesterone only pill?

A

thickens cervical mucus

243
Q

what is the mode of action of levonorgestrel (levonelle)?

A

suppresses ovulation

244
Q

what is the prophylaxis given for group B strep?

A

benzylpenicillin

245
Q

what is a myomectomy?

A

a surgical procedure to remove uterine fibroids

246
Q

what is the criteria for a diagnosis of gestation diabetes?

A

fasting glucose >5.6mmol/l
OR
2 hour glucose level of 7.8mmol/l

remember 5678

247
Q

what is the first line for infertility in PCOS?

A

clomifine

248
Q

what are the 3 causes of increased nuchal translucency?

A

downs syndrome
congenital heart defects
abdominal wall defects

249
Q

what is the first stage of labour defined as?

A

from the onset of true labour to full dilation of the cervix

10cm = fully dilated

250
Q

what are the rules for methotrexate before conception in men and women?

A

stop methotrexate at least 6 months before conception in both men and women

251
Q

when is anti D given to rhesus -ve pregnant women?

A

first dose at 28 weeks
second dose at 34 weeks
any sensitising events

252
Q

what is the management of gestational diabetes if the fasting plasma glucose is <7mmol/l?

A

trial of diet and exercise for 1-2 weeks

253
Q

what is the management of gestational diabetes if the fasting plasma glucose is >7mmol/l?

A

commence insulin

254
Q

what is the treatment for mastitis?

A

flucloxacillin for 10-14 days and continue breast feeding

255
Q

which 2 cancers is the COCP protective against?

A

ovarian and endometrial

256
Q

which 2 cancers does COCP increase the risk of?

A

cervical and breast

257
Q

what does a snowstorm appearance on USS indicate?

A

a complete mole

258
Q

what is a complete molar pregnancy?

A

duplication of haploid sperm fertilising an empty ovum resulting in 46XX but no foetal tissue

259
Q

after evacuation of a molar pregnancy what does it indicate if the HCG levels are not falling?

A

persistent trophoblastic disease

260
Q

what is the most severe form of persistent trophoblastic disease?

A

choriocarcinoma

261
Q

when is the progesterone only injection contraindicated and why?

A

women over the age of 50 because of the effect on bone mineral density

262
Q

is it safe to breast feed with hep B?

A

yes because hep B cannot be transmitted via breast feeding (unlike HIV)

263
Q

what is post party thyroiditis?

A

post partum thyroiditis = an autoimmune condition which presents as the body transitions from the immunosuppressed state of pregnancy back to normal immunity

264
Q

how is post party thyroiditis treated?

A

beat blockers

265
Q

what should be done if a woman w/ known placenta praaevia goes into labour (w/ or w/out bleeding)?

A

emergency c section (category 1 c section)

266
Q

how is post party thyroiditis diagnosed?

A

based on clinical manifestations and thyroid function tests alone

267
Q

what is the management of post partum haemorrhage caused by uterine atony?

A

syntocinon followed by ergometrine

268
Q

what is the best way to assess ovulation?

A

day 21 progesterone

269
Q

which HPV strains are most commonly responsible for cervical cancer?

A

HPV 16 and 18

270
Q

how often are women aged 25 - 49 offered cervical screening?

A

every 3 years

271
Q

how often are women aged 50-64 offered cervical screening?

A

every 5 years

272
Q

what is the management ion cervical cancer ?

A

hysterectomy or radical chemoradiation

273
Q

when can you restart hormonal contraception after taking ulipristal acetate?

A

5 days

274
Q

how long is contraception needed after menopause?

A

<50 = 24 months after last period

> 50 = 12 months after last period

275
Q

what should be suspected in pts w/ continuous urianry dribbling after a prolonged labour?

A

vesicovaginal fistula

276
Q

after giving birth when is contraception needed post partum?

A

21 days

277
Q

what is the first step in possible endometrial cancer?

A

transvaginal ultrasound

278
Q

what is the definition of pregnancy induced hypertension?

A

the onset of hypertension after 20 wks gestation in a women who was previously normotenisve

BP > 140/90 AND proteinurea OR other organ involvement

279
Q

what is the first line for hypertension in pregnancy?

A

labetolol

nifedipine if asthmatic

280
Q

when should magnesium be stopped when used for the treatment of eclampsia?

A

24 hrs after delivery or the last seizure

281
Q

what is the classic triad of vasa praevia?

A

rupture of membranes
painless vaginal bleeding
foetal bradycardia

282
Q

what are the guidelines for prescribing anti D to women having an abortion?

A

prescribe anti D for women having any abortion after 10 wks

do not prescribe anti D for women having a medical abortion before 10 wks

consider anti D for women having a surgical abortion before 10 wks

283
Q

what is the medication of choice for suppressing lactation when breast feeding is being ceased?

A

cabergoline

284
Q

what does a boggy uterus indicate?

A

adenomyosis

285
Q

what is adenomyosis?

A

the presence of endometrial tissue w/ in the myometrium

286
Q

which pt demographic is adenomyosis most common in?

A

multiparous women at the end of their reproductive years

287
Q

what is the first line investigation for adenomyosis?

A

transvaginal ultrasound

288
Q

what is mittelschmerz?

A

benign preovulatory lower abdo pain that occurs mid cycle

289
Q

what is ashermans syndrome?

A

intrauterine adhesions

290
Q

is aspirin safe in breast feeding?

A

no

291
Q

what are the three features of Meigs syndrome?

A

a benign ovarian tumour
ascites
pleural effusion

292
Q

what is the likely diagnosis of a woman > 30y/o w/ dysmenorrhoea, menorrhagia and an enlarged and boggy uterus?

A

adenomyosis

293
Q

what is the mode of action of the COCP?

A

inhabits ovulation

294
Q

what is the mode of action of the implantable contraceptive?

A

inhibits ovulation

295
Q

what is the mode of action of the copper IUD?

A

decreases sperm motility and survival

296
Q

how are vesicovaginal fstulae diagnosed?

A

urinary dye studies

297
Q

what is the impact of smoking on hyperemesis gravidarium?

A

smoking decreases the risk

298
Q

what is the first line investigation for per term pre labour rupture of membranes?

A

speculum exam to look for pooling of amniotic fluid in the posterior vaginal vault

299
Q

what is the diagnosis when US shows crown rump length >7mm and there is no foetal heartbeat?

A

diagnostic of miscarriage

300
Q

what is the first stage of labour?

A

from the onset of true labour until the cervix its fully dilated (10cm)

301
Q

what is the second stage of labour?

A

from full dilation to delivery of the foetus

302
Q

what is the third stage of labour?

A

from delivery of the foetus to complete delivery of the placenta and membranes

303
Q

what is lochia?

A

the passage of blood and mucus etc post partum

304
Q

how long is lochia normal for?

A

4-6 wks post partum

US needed if persists for longer than 6wks

305
Q

how often should women who have had CIN be offered cervical screening?

A

every 6 months

306
Q

what is the diagnostic triad for hyperemesis gravidarum?

A

5% pre pregnancy weight loss
dehydration
electrolyte imbalance

307
Q

what is the management of syphilis?

A

single IM benzathine benzylpenicillin

308
Q

at which point should fibroadenomas be removed?

A

> 3cm

309
Q
A

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